Oh, this one's on, too? Okay. You guys ready? Yeah. Standing room only. Yeah. Good afternoon, everybody. Welcome to this session. Hope you guys are having a great conference so far. We do have some people standing in the back, so if you have an empty seat next to you, will you hold up a hand? So those in the back, oh, we've got plenty of places to sit, so don't be bashful. Come find a seat. Thank you, thank you. If you notice somebody standing, then just wave them over. We're all friends. We're all family, right? Well, this is going to be a great session. This session will be presented in a panel format by our peers, and around 60% of all of our sessions are presented by our member peers. And so pearls and great takeaways can be found from this group, and just a couple of ground rules, housekeeping items, and by now you know the drill, silence your phone or turn it off. Feel free, though, to use your social media platform of choice to post photos or other posts about the conference. Use the hashtag AAOE2023. At the end of the course, please make sure that you fill out the session survey. It's very important for our annual conference council to see the feedback from our attendees on each and every session. You can do that also on your app, if you have that, or if you are old school and want to do a paper evaluation, there are some forms in the back of the room. There are some seats available, so feel free. If you see an empty seat, I don't know, has anybody, or I don't think anything's saved, so if you want to come find a seat, then make yourself at home. In order to receive credit for the session, be sure to use the mobile app and click on the check-in icon. The check-in code for this session, maybe this is on the screen too, the check-in code for this session is 412068, 412068. You guys don't forget to check-in too. If anybody should get credit for this, it should be you guys. The session today is Secrets of Top Performing Practices. Let me introduce the panelists. Panelist number one, Cathy Higgins. Cathy, give us a wave. Cathy is the CEO, CFO of the Boulder Center for Orthopedics and Spine, a 15-physician orthopedic group in Boulder, Colorado. Cathy has been with BCOS since 2016. Cathy was with the Boulder Valley IPA, a local independent provider association, for 18 years. See, when I hear Boulder Valley IPA, I think of something, right, right, I think of a brewery, right? She has an extensive practice management background, having worked for two national consulting firms prior to BVIPA. Cathy began her healthcare career as a staff auditor with Arthur Anderson and Company, where she performed healthcare audits. She has been in the healthcare arena for over 35 years. She lives in Boulder with her husband and has two grown children. She's also a world champion ice climber, I just learned, so... No. Everything was true except the last part. Sally Martin is the director. Where's Sally? Sally Martin is the director of revenue cycle management for New Mexico Orthopedics. Sally has worked on orthopedics, worked in orthopedics for over 40 years, primarily in management, coding, and accounts receivable. She continues to enjoy the challenges and learning opportunities that present themselves every day in her fast-paced practice. Tricia Skilledhouse. Did I say that, I said that right, right? S-C-H-I-L-D-H-O-U-S-E. You didn't think I would do it, did you? Tricia has over 20 years of healthcare leadership experience. She has held various leadership positions throughout her career and is currently the practice administrator for Shoreline Orthopedics in Holland, Michigan. Tricia is a fellow of the American College of Medical Practice Executives. She holds a Bachelor of Sciences in Business Administration and a Master of Business Administration. In addition to her membership in AAOE, Tricia has active memberships both nationally and locally with the MGMA, the Healthcare Finance Management Association, and the Society of Human Resources Management. Samantha Flock. Samantha? Yeah. Samantha Flock's experience in healthcare has included working as a clinician and as an administrator in a variety of settings, including orthopedic physician offices, physical therapy clinics, and in high school. After working several years as a certified athletic trainer, Samantha returned to school to obtain her Master's in Health Services Administration. Since joining the Orlando Orthopedic Center, Samantha has gained experience in managing a branch, overseeing marketing and multiple ancillary services, performing business development analytics, and now overseeing revenue cycle and AP departments. Samantha looks forward to continuing to learn and to grow within the healthcare community. And our fifth panelist, Cindy Hobbs. Cindy Hobbs is the Director of Finance for South Florida Orthopedics and Sports Medicine in Stewart, Florida. Won an award today, right? Yeah, they won the Outstanding Practice Award today. Cindy has assisted in the practice's growth from nine to 21 physicians. Cindy received her Master's of Accounting from Florida Atlantic University and her BA in Finance from the University of Florida. She has over 14 years of experience in healthcare accounting operations, building financial models and monitoring cash flow for efficiencies to achieve growth. She enjoys the challenges of the healthcare industry and spends her free time serving on a local humane society board and with animal rescues. Please join me in welcoming the presenting panel for today's session. Thank you for that nice introduction. All right, so as he just introduced our panel here, we're going to be going over four different metrics today, which is going to be the percent AR 30 to days, zero to 30 days and our net collections ratio overhead by net collections and staff costs as a percentage of revenue, revenue per patient visit and cost per patient visit and also surgical cases per visit and also staff per 1000 visits. Nobody has any financial disclosures for this meeting and the primary point of the meeting is to help leverage some of the experiences of the top performing practices to be able to incorporate some of the secrets that they've gained knowledge of over the years and also to compile some strategies for effective use of benchmarking data. All right, so for our percent of AR zero to 30 days, our first questions are going to be for Sally. So, Sally, what is your priority for accounts receivable in that collections? Our biggest priority is getting our clean claims out the door just as quickly as we can. We do owe a lot of that to our physicians, actually, about 90 percent, maybe a little more than 90 percent of our physicians complete their notes the same day, which really helps with the process getting those claims out the door quickly. We do employ certified coders and we do spend a lot of time in the training and auditing of the coders because we want things to go out cleanly, accurately. We want to avoid audits. And so I do spend a lot of time in training and auditing for our coders. With our system, we have a lot of edits on our system. Those edits are both demographic edits to make sure that all of the fields are filled out, as well as our coding edits. We have a plethora of coding edits, so many that there are times when I suppress some of the edits. And probably one of the biggest things is we really treat every day like it's the end of the month. So the coders all know that their goal is to complete their work on a daily basis. There is some rollover. We do have some busier days during the week than others. They know that Friday is a light day, so Monday is a catch-up day if they need it. But we really try to keep on track with getting all of our visits in. We do have 73 billable providers. Twenty-nine of those are physicians. We have 15 PAs or had 15 PAs at the time in 2021 that this was done. We also have 29 therapists between PAs, OTs, and PTAs. And we also have an MRI unit. So we do have a lot of volume, and we just try to keep up with that on a daily basis. What would you say some of your struggles have been over the past several years? Over the past several years, obviously the pandemic. We had just moved into our brand-new office at Winrock. It's in a retail space, a large building. It used to be an old Montgomery Wards. So we – interesting. We had just moved in January 20th of 2020 when everything hit. Luckily, our IT team was ready, and we were able to send a lot of our back office staff home within about 24 hours, honestly, with the use of Citrix. We had them use their own computers at home. So we were able to do that pretty quickly. Our state was one that was shut down pretty significantly, about 25%. So navigating the whole remote working was a challenge. Communication between our departments was a challenge. We used instant messaging to kind of have everybody come together. And authorizations. So authorizations have been a challenge for our practice. We've really increased the communication between our departments. At one point, everybody was so stressed. We kind of like just deal with what's on your plate. And then we finally got to the point where we could open up communication again between the departments and give feedback about what was being denied, what wasn't, what was working, same with eligibility. We had some challenges with that as well. Do you have any tools that you feel have helped with this process of sending out clean claims? So our practice management system, we're on Athena Practice, formerly Centricity Practice Solutions. We've actually done really well on that system as far as the system setup, the edits from that system. We did change our eligibility tool from the one that was sponsored by the system in about June of 2021. We did have one of our largest payers that wasn't available through our main eligibility. So that helped us out a lot. And then our coding edits was hosted claims manager. Do you feel like your payer mix has had any influence in being able to keep the claims low? Definitely. So in our state, we have uniquely a large local payer, which is about 30%, 36% of our payer mix. They do have all lines of business, whether, you know, a combination of commercial, Medicare, and Medicaid. But it is 36% over a third of our business. They actually pay us pretty quickly in about 23 days on average. Medicare is up there too. We have 18% Medicare, which is about 28 days in AR and Blue Cross another 18% at 29 days. So those, just those three payers make up 72% of our payer mix and all of them pay us pretty quickly. Perfect. Thank you. Just opening it up to the rest of the panel. For instance, Tricia, do you have any things that, anything that you feel is working for you in this area as well? So we do have a little bit of challenge in this space, but our corporation is trying to become a little more data driven, which is why we really love the AAOE benchmarking. So we are working on having audits for staff. So Sally mentioned that they've got edits in their system for demographics. And I don't know if any of you experience this, but we kind of have a front office back office kind of a situation where, Oh, the front never gets the right insurance information or the, they never have the name correct or whatever. So we're actually auditing that and we're giving that feedback back to the people that are actually responsible for getting the information and also giving the feedback back to the team that claims that the front team is not doing that. One to actually showcase that we are listening to them and then also showcasing that, you know, they might have missed five, but they got 200 correct. And unfortunately it was five for you, but overall it was they had a better percentage. So we're trying to bring down those emotions and actually just show people, okay, this is what is happening. And then when we review those, we can kind of determine, okay, it's this particular insurance that they struggle to put in. All right, well let's give them some education. So it's not a punitive, it's really just an opportunity to grow the team and have them be a little more responsible for exactly what they have accountability for. Thank you. Does anybody else have any other input? Do you want to pass the mic to them? You know, one thing we're the result of two groups that merged in 2016. So I feel like the first two or three years it was just trying to keep our heads above water. But recently we've gotten to the point where we can look and see what we're could do better. And using the benchmarking data and other sources, you know, we're going in and establishing key performance indicators across all departments. So that managers actually have something to get their staff to try to work towards. So I think that's been helpful and makes it more objective. So next is our overhead by net collections and staff costs as a percent of revenue. And so Tricia, for this one what contributes to your results in this area, would you say? So in looking at things, I think that probably we all do look at these things and say, we're doing this well. So I try to come up with some things that maybe not everybody is doing. So leases, for example, our physicians do own our building. And so we are able to set our lease rate. We do have to be a little bit cognizant of the fair market value because we do share the building and lease to a hospital partner. So we do make sure that we are fair market during COVID. We had the opportunity that we could suppress the lease. We could play around with that a little bit. That sounds kind of fishy, but I think we all kind of did what we could to survive through COVID. So we were able to reduce that and just had that flexibility. Another thing with the owning your building is the CAM expenses. We have the opportunity to actually look for a lower cost alternative for cleaning and things of that nature. We're not just in a building where the landlord doesn't really care what that expense is because they're just passing it on to those that they are leasing to. So that has been a benefit for us. We also belong to a couple of different GPOs and we try to leverage the GPOs and the prices for various things. We have one person that is dedicated to a lot of our ordering. And so they will track the different GPOs and where they can get the supplies for the least amount. And then we also do try to leverage technology. For example, we had somebody that went on maternity leave and just as we knew that it was coming, she was one of our revenue cycle team members and she made the phone calls for patients that were about to go to collection. So we entered into a contract with a vendor that just we uploaded a report. They sent text messages or emails out to the patients and there was a link for them to pay. And so we leveraged that technology piece. Perfect. So in reference to staff costs as a percent of your revenue, what approach to staffing has your practice taken? So we try to have everybody working at the highest level of their licensure or certification. So that way, like at one point we had APP team members that if we didn't have enough medical assistance, they were going to the front and getting their own patients. Well, that's a very dissatisfier to them. And it's also a very costly person that is rooming a patient. So we try to have everybody doing value added things and working at their highest level of certification. We also do the benchmarking to compare salaries so that we can stay competitive, that our benefit package is competitive. We do also benchmark locally to our employers association so that we can get other industry data because when we looked at, okay, well, why are people leaving and where are they going? They were going to things outside of healthcare as well. And so I think also post COVID everybody likes to say, okay, well, people don't want to work anymore and they don't want to put in effort, but it's our finding and belief that they are looking for something better or something that maybe pays a little bit different for the work. So we try to benchmark ourselves against the other industries that we would see our team members leaving for. Perfect. And what role would you say that technology has played in managing your overhead? So as I mentioned before, we did implement a technology service that helped us with collections for people that we were getting ready pre collections that we were getting ready to send to collections. So we do try to look at different things for some of the roles that people are doing that could technology help us. And we are a 10 position group and an eight APP group. And so I feel like we're a large enough size that we can afford to introduce technology, but we're also small enough that we're can be nimble. So if it doesn't work, we can make the decision, okay, let's move on to something else. Perfect. For the rest of the panelists, how would you say that you're managing your staffing costs and overhead at your practice? Do you have anything that you can share with us on that? Okay. so for our revenue per patient visit and cost per patient visit, for Cindy, what would you say has helped you with your results in this area? Well, at South Florida Orthopedics, we're an all-encompassing orthopedic group. We have ancillaries. We like to be like the one-stop shop for our patients, so they can come in and get all of their services done with us. We've also put a lot of efforts and resources towards patient satisfaction. There's a direct correlation with increased satisfaction. You're going to have increased revenues. And we're finding that if we can keep our patients happy, they're going to tell their friends and the ambassadors out in the community to report back to, you know, have them come to our practice as well. So we put a lot of efforts into that role. Also, we have a fluoroscopy suite, so we do a lot of high-revenue-generating procedures in office. We've got three spine physicians, and they do kyphos. And if anybody is aware, they're pretty high-paying, so that helps a great deal. We also do epidurals. We've got two PM&Rs, so we do quite a bit. Our fluoro suite runs five days a week, 10 hours a day. We also have an in-house procedure room. It's in our walk-in clinic, and our hand surgeons will do their trigger finger releases. They'll do their ultrasound-guided carpal tunnel releases, so that also brings more revenue into the practice and less out. We don't have a practice on ASC, that's the only thing, so we do PRPs. We also were very successful in the BPCI program. It was such a win-win situation for both the patient and for the physicians. So when it moved out of joints into the spine arena, we sort of backed off a little bit, but hopefully in the future, we'll revisit that. We have, there's a vendor here that we work with. We do simple bundled payment option for our direct-pay patients, so we collect the money up front. They come in, they know exactly what the services are that they're getting and what they paid for, so there's no surprises there. Contract renegotiations, we make sure our contracts have inflation indicators. We make sure that we're always looking at focusing on the total reimbursement, you know, we give up something to get more, looking at the number of procedures that we do and making sure we're getting the best possible contract for that. And then we just work, like everybody else, we work hard at producing clean claims. This time around, I've been re-energized by some of the vendors here today to hear their zero-touch policies and things like that, so I'm very excited about looking into what they have to offer. Do you feel like your practice structure has had any influence in this at all? Oh, absolutely. We have 21 physicians. We have 43 providers in all, but we have 21 physicians, spine, hand, sports, revisionists. We have a pediatric ortho, we have podiatrists, we have a non-surgical physician. He actually sees a lot of the back if we can't, you know, spine is very, very busy, so if we can't get them into a spine position quickly, we use our non-surgical physician, and he knows the protocols of the surgical physician, so he's able to assist with that, so that helps a lot. We had a rheumatologist, but she got pregnant and left, so it wasn't the most lucrative, but it was just another service we provided for our patient base, so that was good. And then ancillaries, we have full imaging. We have two MRIs. They go six days a week. Always busy. If they're not down, that's always been a problem. We have our ortho walk-in clinic, and it's in the same building as one of our practices, so if a patient comes in and they're acute enough, we can send them right upstairs to see a physician, but it's manned by a PA, and it seems to be doing really well. It's very lucrative. PTOT at all locations, buy and build DME and non-narcotic medications. That's been very lucrative. I don't know if anybody's reached out and worked on that, but that seems to do well, especially with work comp patients. We have Floro. I think I spoke about that as well, and then we also have an in-house procedure room. That's part of our walk-in clinic, so that's where our hand therapists try to do their procedures. Do you do anything special with marketing? Oh, yes. Absolutely. We actually are... How do I... Make sure I say this right. We are the orthopedic group for a baseball team that winters in our area, so we sort of reach out to the high schools. We try to be the orthopedics there during their sports events and things like that. We just hired a new marketing specialist, so more things to come. Perfect. Kathy, did you have something you wanted to... I was just curious what the hours of your walk-in clinic is. What my... The hours. Oh, okay. The hours are 8 to 7, I want to believe, Monday through Friday. Saturday, we're open, I want to say 9 to 2, and we are not open on Sunday, but in listening to others speak this weekend, a lot of you have a lot longer hours than we do, so maybe we need to open that up. The problem is staffing. Do you mind sharing some information about cost per patient visit? Sure. You actually took a lot of the wind out of my sails here, but it's okay. So like everyone else, after COVID, we had to sort of accept the environment that everybody was facing with regarding to staff, so we spent a lot of time cross-training our staff to make sure that they could do multiple things within the office and move them where we needed to move them to. Also technology. We are actually moving in the direction of getting away from doing the old way with paper and moving into technology, and that's really helping a lot too, because it seems everything that we put on, it helps us with our FTEs. It's just having the right drivers of the technology that's important. We also use multiple group purchasing organizations. We're part of OrthoConnect, OrthoForm. We've been very successful with that. We do contract pricing on any of our high medical supplies that we need, to give you an idea, like the Kyfo kits. We just make sure we get the best pricing possible, and we're always staying on top of that. Our physicians, some of them tend to do open templating, so within the same given timeframe of a day, they see more patients, so that really helps a lot. They don't have one new patient per hour or anything like that. They'll see anything and everything within the timeframe that they feel that they can see patients and still give them quality care. We have a below national average of a no-show rate. We only have a 5% no-show rate. We spend time during the day making sure that we call our patients or text our patients, make sure they know that their appointment's the next day. The national average is 18%, so 5% is pretty good for us. We have tight purchasing and inventory controls, being the revenue department, I can tell you that I'm really tight on purchasing, so we really watch inventories for theft and loss or waste. And then we also have physician-owned real estate, so we're allowed to do fair market value on our rents. We try to be very cognizant of our tenants as well, that we don't undercut them. But we can also manage the costs, and I think that's the biggest key here, is that we can manage what's being spent. We can do a lot of the services in-house. We can use people that are already in-house so that we don't have to go out and purchase. Can't do the plumbing, though. That's the problem. I think plumbing and AC is probably two of our biggest costs when it comes to these kind of things. But that's all helped with keeping our costs down. Thank you. Do any of the other panelists have anything they'd like to contribute to this topic? I actually have a question for you. Back to the ortho-urgent care, you had said that your providers, if there's something that is more complex for the APP to handle, that they can just go right up and see a provider. And you mentioned open scheduling. Do the providers have openings throughout their schedule to accommodate? Well, not for the most part. If it's a spine surgeon or if it's a hand surgeon, anything like that, they wouldn't really have any openings. But some of our generals, they might have an opening that they could go ahead and see them. And if not, we try to fit them in. We just do the best we can. But we don't want to send them home and then bring them back or have them go to the hospital or something. Perfect. Thank you so much. Appreciate it. So surgical cases per new visit and staff per 1,000 visits. So Kathy, how do you keep such a high ratio of surgical cases per new patient visit? When I was asked to talk about this, it was actually news to me. It isn't something we necessarily strive for. So in thinking about why, because it's not that we operate on everything that walks in the door, we have a really sophisticated primary care network where we are. We're part of a clinically integrated network with our local hospital. And they employ over 100 primary care physicians. And they have a centralized referral system. And with one of the large payers, we're getting reporting. And I honestly think it just is due to the sophistication of the primary care network. They work people up. They have good communication with our physicians. For our total joints, probably 80% of those folks walk in with their x-rays. Their primary care has already taken an x-ray, sees their arthritis, knows that they're a candidate. And so I think it's just, you know, I think really that's what it is. We also, you know, we live in a college town. It's a very healthy environment. And if anybody's ever been to Boulder, Colorado, you just see people riding their bikes and running everywhere. They're also really highly educated. So I think people do education on their own to see. I mean, and that's a double-edged sword, you know, because they come in with, you know, their little thing and say, well, doctor, I know what's wrong with me. It's this, this, and this. But truly, I think they've done some research, seen other people. You know, we have a non-operative physiatrist who I think helps kind of weed out, you know, some folks. But, you know, that's really the only thing I can honestly think of that might be different. And I don't know that you can create that, you know, but I think we're just lucky where we practice. How do you feel your staffing structure has influenced this? Well, as the person who introduced us said, you know, I'm the CEO and CFO, so we make everybody do two jobs. That cuts it down right away. No, you know, we've just been lean and mean. When we merged, we were two medium-sized groups, like five, six doctors each group. And they were lean, very lean. And so when we merged, you know, I've always been very focused on overhead. Every month I'm calculating what it is, reporting what it is, very proud of what it is. But it does, you know, it's creeping up a bit. I think we're finally at the point where we're adding the infrastructure we need. So I'm building up the whole finance side. We do outsource IT, so I think that helps, you know, that outsourcing thing. We use Athena, so I think our number of billing staff is probably lower than the national average and they're good. They've been doing it a long time, you know, so they're effective. But I just recently, about a year ago, hired a Director of Revenue Cycle Management, hadn't had that before, you know, in addition to a billing manager. So we're starting to add more, you know, layers. So I don't know that we'll necessarily stay this way, but I think we just have great staff that do everything it takes. I'm told our medical assistants do more on average, like we don't have surgery schedulers. I think we're going to start hiring some. I know our medical assistants do all the surgery scheduling in addition to rooming patients and everything else that they have to do. So. Perfect, thank you. And then if you don't mind, I'm going to pull it back to Tricia. Do you have any areas of improvement for this? Yeah, so when we were meeting and talking about this panel discussion and listening to Kathy and the things that she was doing, I thought to myself, we struggle a little bit with access within our clinic. So one of the biggest drivers for that I see is that our physicians haven't quite gotten to the point where they're willing to turn their referral over to their APP. I don't know if anybody else is experiencing that or not, but we do struggle with, well, you know, this physician that I have known for 20 years is referring this patient to me, so I need to see that patient. So we are working on trying to change that thought process and patients that we have found like we've had a referral waiting for a while. And then all of a sudden the patient will disappear. It's like, OK, they took a quicker appointment someplace else than waiting for you. I'm sorry for what that does to your ego or whatever, but we need to work on getting those patients in quicker. And then if the APP can see them, if they aren't quite optimized for surgery, then they can transition to the surgeon and kind of move that metric a little bit for us to have a case be a surgical case. And then we have a little bit of issue with block time that we work through with our hospital. Perfect. So does anybody else have any input on this topic that they'd like to share? No. So before I open it up for questions, I just want to thank you ladies for taking the time today and being willing to share some information about your practice. Also on the front table here, we do have little pamphlets about the insights for the benchmarking. So I'd encourage you to come kind of take one of the booklets, read through it, let us know if you have any questions. And then we'll go ahead and open it up for questions. Do you have any? Yes, ma'am. I have a question on coders. Do you have them coding both surgical and office visits? And then how many coders do you have? And if you don't mind repeating her question so everybody can hear. Sure. The question is how many coders do we have and what types of services do they code? Currently we have nine coders. Three of those are what we consider coder twos. So everyone starts as a coder one. I have folks that, you know, have a lot of experience in ortho, not necessarily with our practice or maybe our services that we provide. So everyone starts as a coder one and works their way through all of our provider types, all of our services, works their way out through the surgical realm, MRI, PT, as well as our, probably the most difficult ones to code are on-call cases. So once you can do everything, you become a coder two. And the coder twos are the ones that do the surgical cases and the on-call cases. We have 73 billable providers. We have 20, sorry, it's ever changing, it seems. We have 29 at this, in this period, we had 29 physicians. We actually had a few less at that time, a couple of years ago. We've added one more. We've had some in transition, but we do have nine currently for about 30 providers. Actually, I didn't count MRI, but we do. So we do currently have two MRIs. We do have, at the time we had 29 physical therapists, occupational therapists, and PTAs. PTAs are a billable provider, but they do add to the volume. Yeah. Yes, in the back. We leave the initial work to our account reps. So our account reps scrub through the denials, figure out exactly what the denial reason is, and then they put them into coding review with their notes on that particular visit. And then our coders will scrub through the coding piece of it to decide if it is modifier related, or if it was a bundling issue, if it's something that we should accept on the coding side or not. They will go through the documentation, through the op reports, mark them up, and then send it back to the coders so that they can use that in their appeals. We have not. We had one of our EMRs, two EMRs back, had supposedly the ability to code E&M services. We found that it was over coding on the E&M, so we didn't use that. But no, we have not. We do have one bit of help on the surgery center side. So we're part owners in the surgery center. And they use not an EMR, but probation. I'm sure some of you are aware of that. So they can create their op reports through the ASC, through probation. Our IT department set up an interface so that we have those codes coming through. Our coders still review the op reports, make sure everything's appropriate. But that has been a huge help as far as automation. Right, so we have 15 physicians. And so it's a one-on-one with each physician. But most of our surgeons, they're all surgeons but one, are in office half, in surgery half. And so those MAAs will also, they'll have some admin time when they're physicians, but they don't get a lot or enough probably. But then they're also then helping with the PAs. The PAs, it's not a one-on-one. They're not guaranteed who their medical assistant's going to be. And we've had trouble, like I'm sure everybody has, keeping radiology technicians. So we're incentivizing our MAAs to become limited scope so that they can do that role. And we pay for it. There's a wage differential. It's kind of a win-win. And we do have, although we've had trouble keeping, I mean, I think everybody's had staffing challenges since COVID. Ideally, we have a float MAA or two to just kind of fill in as people are sick. But like I said, I think that's the main area. The other thing I thought of when you said you had nine coders, we outsource our coding as well. So that affects your staff per 1,000 visits as well. No, one does. Our busiest hand surgeon. I know. One has like one and a half. Whenever he's in clinic, they're both with him to help with what they do. And then the rest of the time, she's a float. But so he's in clinic three days a week, though. So yeah, he gets one and a half. So he does, but nobody else does. If I could add to that, I think it's really important if I can add to that. We base it on how many patients they're seeing. So if they have more than, let's say, 18 in their clinic for the morning, we'll add a float. So many of our physicians all have two, but they have their primary and then the secondary. And then we have floaters, but rarely more than that. Oh, my gosh. Well, we've had some sometimes have three, but. Oh, and in the front row over here. We do. So, I mentioned the one technology that we use for doing our pre-collection phone calls. We also do utilize one of the surgery scheduling technology things, and we find that to be very helpful. Prior to that, we had a lot of spreadsheets that were happening. Some of them were shared spreadsheets. Some of them were on each individual computer, so it was very challenging when somebody was sick or whatever to step in and take care of surgery orders. And so, with it being in a system, we are able to have other people step in and help and do those kinds of things. I'm here with my director of operations as well, and one of our takeaways and goals of coming to this conference was, okay, let's make a spreadsheet of all the technology that we currently are using, what is the problems that we're trying to solve, and okay, what technology have we talked with, and then let's start to look at the expenses. Let's start to look at where they cross over. Can we consolidate some technology, because we use a texting service for our surgical patients. The patients will sign up, and then they will get at the appropriate time from when they had their surgery, hey, it's time to start doing this exercise. Hey, you can shower today or those kinds of things, and so that has really decreased phone calls. And so, we're able to monitor what patients are texting back to get more information on, so then we can modify our workflows prior to surgery and educate patients a little bit more. So, we're really just kind of trying to undrown from all of the technology and just have more of a strategic approach, like, oh, you know what, this is the new and fun thing. Okay, well, now it's this, and then you get that from your surgeons or your physicians in the group. So, we're really just trying to take a strategic approach to say, this is what we're doing, this is what we need to solve, and this is where we need to go and consolidate, because many of them are starting to venture, like, they started with this, and now they're doing this, and you lose track of it, and all of a sudden, you've got all these services that you're paying, and they could, you could stick with one vendor to remove another vendor. Yes. Our current eligibility vendor is ClearWave that we've been using. So, we have more, we have more patients that we can verify through the tool. We do have unique things like Blue Cross, where we're not participating with every plan, and therein lies the issue with trying to weed out those plans that we don't participate with, and not having those patients slip through, because they do come in active. So, it is still a challenge. It's not perfect, but it is better than where we were before. Yes, ma'am. That's a good question. When you say clinical side, like, you know, those are actually in development, to be perfectly honest. The easy ones to put in place are the financial ones, and I'm financially oriented. So, my COO is here with me. I don't know if you want to speak or answer that question for us, Colleen. So we are using health I pass I believe that they were a vendor here as well but we actually had used them for our check-in kiosk before we switched EHR so we when we switched EHRs the our current vendor didn't integrate with them and wouldn't integrate so we were a little sad about that because we really did enjoy all of the features with it we actually originally launched them because they could do a credit card on file program for us and so they actually had reached out and said hey you know can we do anything for you in in any kind of space and and so we just run a report out of our EHR send it to them and they they shoot those texts and emails out and when I looked at information most patients if they were going to pay they paid that same day and these would be people that historically we would have sent to to collections and from a cost perspective it's it's reasonable and we can't say cost but you can you know reach out to them but yes health I pass yeah No, we are not at Shoreline. I did talk to a vendor that does use AI from a phone call perspective, that if they wanted to confirm an appointment, I'm not sure how they did it. It was a very quick conversation I was going to connect with afterwards, but we're not using anything like that. Any other questions? Yes. When you're dividing up your claims process, do you divide it by payer, provider, or specialty? So on our coding process, when we're getting our claims out the door, getting our charges into the system, we do that by provider. So we start, for instance, a brand new coder with physical therapy because it's what I call one dimensional as far as coding, and it gets the user used to our system, our workflow, looking in the chart. And then we progress on to physicians, our physiatrists, less global, you know, not a lot of global periods there. And then we just keep building on adding coding rules as we go. For our collectors, though, we actually assign their work by payer. Anybody else? Yes, ma'am. No, we don't. Just the experience with our practice that they can actually perform coding for all of our services. They can actually at that level, they can answer any coding questions. They can support our clinical staff. If we have new MAs that are not sure of the coding for surgeries, they support that. Estimates, self-pay patients, that type of thing. So they do go into another level of mastery, basically, but not as far as coding certification. We used to hire, it was more difficult to actually pre-pandemic to find certified coders than it has been post-pandemic. I think a lot of people had a change of career path. So previously, we would hire coders in the pretense that they would become certified within a year. And luckily, we've been able to change that a bit because I do find that the certified coders just start out much stronger and are able to perform and do better in their position. For our practice at New Mexico Orthopedics, we have been lacking behind in technology as far as checking in patients automatically. We have a system now where we do minimal work at the time of check-in. And the idea is that everything is totally done, but the reality is that everything is not totally done when they walk in the door. So we're working on technology for checking in the patient prior so that they can review their demographics, upload their cards. We do have automated reminders, of course, for our patient appointments. We do collect co-pays 23 hours in advance for our patients. Currently, we do use texting quite a bit, but we're really working on the automation of the back-end process as far as patient balances, texting, and that type of thing. So I guess the thing that I see on the horizon is orthopedics kind of functioning as a commodity. And how do we function in that kind of a world? I feel like I think that Kathy, you made a comment about people come in and they already feel like they know what is their circumstance and what do they need. We're overloaded with information. So I feel, and I feel like the payers also kind of treat the practices as a commodity. And so how do you function in that? Does it become, and there's all kinds of different sessions that were on this. Do you become a super group? Do you do PE? Do you do different things? And so I think it's challenging to just figure out, okay, how do you show people the value of what your surgeons, what your physicians bring to the patient care experience? And then just working with the payers to say, okay, we are not a commodity. We are helping patients. We are improving their musculoskeletal care. We should be compensated for that appropriately. And just, I guess, looking at ways to just survive as a private practice. And I totally agree with what they both said. I think it's, you know, really employing technology to prove what we all know and your value and your quality, you know, collecting patient reported outcomes, doing automation. We've had online scheduling for a few years now. And overnight, that was just, you know, it's amazing. And you take, you know, the front desk out of that loop. We don't have a call center. We just have front desk folks. But we're trying to make that process better, you know, putting out more bundles. I mean, visiting the vendors at this conference was amazing, you know, just to see what's out there and, you know, what we need to employ. And, you know, don't get stuck with what you're using today because there could be something better out there. You know, we're on our, you know, third patient intake system. And not that the first two weren't good, they were, but it keeps getting better and better. So. Yeah, you know, one of the biggest things we've done in, like, the last six months was we have a tool that you can use it for, like, estimations, good faith estimates, whatever else. So we're sending out patient estimates. We have card on file, finally. I feel like we're the last practice to, you know, do that. But we finally did that. And I even had a couple physicians, like, why are you doing that? It's like because you don't go to the grocery store and pay for your groceries in two months. So capturing that information on the front end. And so when we send out the good faith estimate, and then there's a way to pay it. You get out your visa, your HSA card, or whatever it is, and you pay them. So my revenue cycle director just loves to come in and show me. Look how many people just pay it automatically. We've got pages and pages and pages of this stuff. You know, so. Rivet. Well, we're right now for self scheduling, we're using cure for you. But we are looking at relation as well. Just, you know, that and we want to use it, the algorithms for front desk as well, because right now we just have online scheduling and that's great. But when they call. You know, we have new receptionist and inevitably, you know, the hand patient gets scheduled with the total joint surgeon and you're like, heaven forbid, how did that happen? So having, you know, like they have in call centers and, you know, algorithms, so they can follow and get the patient to the to the right place, which our current system, you know, can't do. So we don't have the kiosk set up anymore, because the EHR that we switched to, we're waiting for the version upgrade, and that will supposedly fix all of our problems that we have. It's really quite amazing. I can't wait to get it. But when we did have the kiosk, we still had two at our front, because they had the kiosk right there with them, and we didn't fully transition to just having them in the waiting area or having them do it from their phone in the car, because then we did switch to a different EHR. But correct, yeah, yeah, we were eventually going to go to the kiosks that would be out in the lobby, kind of spread out, but we didn't make it that far. Yes, ma'am. All right, well I think we're about ready to to wrap it up here. We do have the contact information for the ladies here. If you have any additional questions for them, please feel free to email us directly. Just waiting as some people are taking pictures. And then also in reference to our benchmarking, if you're interested in participating in benchmarking this year, please scan this code and we would love to help answer any questions in reference to benchmarking as well. I would just like to add to that if you are hesitant to do it, I just encourage you to to take the dive in and do it and make note of the reports that you are creating in order to submit the data so that you have it for the following years. It's just really valuable to have more people contributing. Benchmarking, it's such a great way to just start to investigate where you might be able to improve your practice and you could be way off from somebody, but it might make sense for where you are and what your environment is, but at least it's an opportunity. I think sometimes we're so overwhelmed with, okay, well what do I work on next? What do I do next? If you look at the benchmarking, you can just say, okay, where am I an outlier? Does it make sense or not? And if it doesn't make sense, then start to ask questions of your team and things. Yeah, I wholeheartedly endorse that. And if you haven't done it before, the first time you do it, you're gonna learn so much about your practice that you just never really thought about because of the way the survey is laid out. So, yeah, please participate if you aren't. Okay, thank you very much. That was a two-day seminar in one hour with the content that we got today. So, round of applause for our panelists, please. And we have presenter gifts. Kathy, Cindy, you all so much. Samantha. We all know it takes a lot of time to prepare for a presentation like this. And we also all know that a lot of spare time is hard to come by. So, thank you all for doing that. Just a quick plug. There are resources available through AAOE. The monthly networking calls, the great interaction, the question and answer that we had. There's an opportunity each and every month. Go on the AAOE website to learn more about when and how to participate in those. And then also our Collaborate online environment. So, there is a wealth of knowledge there. You can search by topic and see if something's already been discussed. An answer that you have has already been asked and answered. Or you can pose a question directly in a particular forum. So, it's a great resource to have a back and forth interaction like you did today with our panelists online. So, please fill out the evaluation either on your app or there are paper evaluations in the back. The checkout code for this session is 580139. How do I get to the page with the checkout code? Perfect. Yeah. So, checkout code 580139. If you are claiming AAPC credits, write this code down. It's 84729XCB. Thank you for coming. Have a great rest of your afternoon. I'm sure the panelists will hang around if you would like to ask a question offline. Thank you. Thank you very much.

medical practice management

revenue cycle management

coding

technology implementation

patient experience

operational efficiency

benchmarking

staffing strategies

financial management

patient engagement